Robot-assisted and conventional therapies produce distinct rehabilitative trends in stroke survivorsReport as inadecuate

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Journal of NeuroEngineering and Rehabilitation

, 13:92

First Online: 11 October 2016Received: 11 May 2016Accepted: 01 October 2016


BackgroundComparing the efficacy of alternative therapeutic strategies for the rehabilitation of motor function in chronically impaired individuals is often inconclusive. For example, a recent randomized clinical trial RCT compared robot-assisted vs. conventional therapy in 77 patients who had had chronic motor impairment after a cerebrovascular accident. While patients assigned to robotic therapy had greater improvements in the primary outcome measure change in score on the upper extremity section of the Fugl-Meyer assessment, the absolute difference between therapies was small, which left the clinical relevance in question.

MethodsHere we revisit that study to test whether the multidimensional rehabilitative response of these patients can better distinguish between treatment outcomes. We used principal components analysis to find the correlation of changes across seven outcome measures between the start and end of 8 weeks of therapy. Permutation tests verified the robustness of the principal components found.

ResultsEach therapy in fact produces different rehabilitative trends of recovery across the clinical, functional, and quality of life domains. A rehabilitative trend is a principal component that quantifies the correlations among changes in outcomes with each therapy.

ConclusionsThese findings challenge the traditional emphasis of RCTs on using a single primary outcome measure to compare rehabilitative responses that are naturally multidimensional. This alternative approach to, and interpretation of, the results of RCTs may will lead to more effective therapies targeted for the multidimensional mechanisms of recovery.

Trial number NCT00719433. Registered July 17, 2008.

AbbreviationsARMinAn exoskeleton robot that allows task-specific training in three dimensions with assistance as needed control

FMAFugl-Meyer Assessment

ICFInternational Classification of Functioning, Disability and Health

MALMotor Activity Log. A structured interview with the patient about quality of movement of the affected arm in the natural, home, and community environment

PCPrincipal component

PCAPrincipal components analysis

PCsPrincipal components

RCTRandomized clinical trial

RCTsRandomized clinical trials

SISStroke Impact Scale. A combination of the four domains of strength, hand function, mobility, and activities of daily living of the complete SIS questionnaire

WMFTfWolf Motor Function Test function-domain. A qualitative measure of motor performance of the affected arm in the clinical environment

WMFTtWolf Motor Function Test time-domain. A quantitative measure of performance of the affected arm in the clinical environment

Electronic supplementary materialThe online version of this article doi:10.1186-s12984-016-0199-5 contains supplementary material, which is available to authorized users.

An erratum to this article is available at

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Author: Francisco J. Valero-Cuevas - Verena Klamroth-Marganska - Carolee J. Winstein - Robert Riener


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